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The comparision among euploidy of preimplantation blastocysts in different controlled ovary stimulation (COH) protocols

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare differences in euploidy rates for blastocysts in preimplantation genetic testing for aneuploidy (PGT-A) cycles after gonadotropin-releasing hormone agonist (GnRH-a) long and short protocols, GnRH-antagonist (GnRH-ant) protocol, progestin-primed ovarian stimulation and mild stimulation protocols, and other ovary stimulation protocols.

Methods

This was a retrospective cohort study from the Assisted Reproductive Medicine Department of Shanghai First Maternity and Infant Hospital. A total of 1657 PGT-A cycles with intracytoplasmic sperm injection after different controlled ovary hyperstimulation protocols were analyzed, and a total of 3154 embryos were biopsied. Differences in euploidy rate per embryo biopsied, embryo euploidy rate per oocyte retrieved and cycle cancellation rate were compared.

Results

For the PGT-A cycles, the euploidy rate per embryo biopsied was lower in the GnRH-ant protocol than in the GnRH-a long protocol (53.26 vs. 58.68%, respectively). Multiple linear regression showed that the GnRH-ant protocol was associated with a lower euploidy rate per embryo biopsied (β =  −0.079, p = 0.011). The euploidy rate per embryo biopsied was not affected by total gonadotropin dosage, duration of stimulation and number of oocytes retrieved. The embryo euploidy rate per oocyte retrieved was similar in all protocols and was negatively correlated with the total number of oocytes retrieved (β =  −0.003, p = 0.003).

Conclusion

Compared with the GnRH-a long protocol, the GnRH-ant protocol was associated with a lower euploidy rate per embryo biopsied. The total gonadotropin dosage, duration of stimulation and number of oocytes retrieved did not appear to significantly influence euploidy rates.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. La Marca A, Capuzzo M, Imbrogno MG, Donno V, Spedicato GA, Sacchi S, Minasi MG, Spinella F, Greco P, Fiorentino F, Greco E (2021) The complex relationship between female age and embryo euploidy. Minerva Obstet Gynecol 73(1):103–110

    Article  PubMed  Google Scholar 

  2. Baart EB, Martini E, van den Berg I, Macklon NS, Galjaard, RJH, Fauser BCJM, Van Opstal D (2006) Preimplantation genetic screening reveals a high incidence of aneuploidy and mosaicism in embryos from young women undergoing IVF. Hum Reprod 21 (1):223–233

  3. Macklon NS, Geraedts JP, Fauser BC (2002) Conception to ongoing pregnancy: the ‘black box’ of early pregnancy loss. Hum Reprod Update 8(4):333–343.

  4. Magli MC, Jones GM, Gras L, Gianaroli L, Korman I, Trounson AO (2000) Chromosome mosaicism in day 3 aneuploid embryos that develop to morphologically normal blastocysts in vitro. Hum Reprod 15:1781–1786

    Article  CAS  PubMed  Google Scholar 

  5. Simopoulou M, Sfakianoudis K, Maziotis E, Tsioulou P, Grigoriadis S, Rapani A, Giannelou P, Asimakopoulou M, Kokkali G, Pantou A, Nikolettos K, Vlahos N, Pantos K (2021) PGT-A: who and when? Α systematic review and network meta-analysis of RCTs. J Assist Reprod Genet 38(8):1939–1957

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bhatt SJ, Marchetto NM, Roy J, Morelli SS, McGovern PG (2021) Pregnancy outcomes following in vitro fertilization frozen embryo transfer (IVF-FET) with or without preimplantation genetic testing for aneuploidy (PGT-A) in women with recurrent pregnancy loss (RPL): a SART-CORS study. Hum Reprod 36(8):2339–2344

    Article  CAS  PubMed  Google Scholar 

  7. Huirne JA, Lambalk CB (2001) Gonadotropin-releasing-hormone-receptor antagonists. Lancet 358(9295):1793–1803

    Article  CAS  PubMed  Google Scholar 

  8. European and Middle East Orgalutran Study Group (2001) Comparable clinical outcome using the GnRH antagonist ganirelix or a long protocol of the GnRH agonist triptorelin for the prevention of premature LH surges in women undergoing ovarian stimulation. Hum Reprod 16(4):644–651

    Article  Google Scholar 

  9. Yang R, Guan Y, Perrot V, Ma J, Li R (2021) Comparison of the long-acting GnRH agonist follicular protocol with the GnRH antagonist protocol in women undergoing in vitro fertilization: a systematic review and meta-analysis. Adv Ther 38(5):2027–2037

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Xia M, Zheng J (2021) Comparison of clinical outcomes between the depot gonadotrophin-releasing hormone agonist protocol and gonadotrophin-releasing hormone antagonist protocol in normal ovarian responders. BMC Pregnancy Childbirth 21(1):372

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kuang Y, Chen Q, Fu Y, Wang Y, Hong Q, Lyu Q, Ai A, Shoham Z (2015) Medroxyprogesterone acetate is an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization. Fertil Steril 104(1):62–70

    Article  CAS  PubMed  Google Scholar 

  12. Filicori M, Butler JP, Crowley WF Jr (1984) Neuroendocrine regulation of the corpusluteum in the human. Evidence for pulsatile progesterone secretion. J Clin Invest 73(6):1638–1647.

  13. Garcia JE, Padilla SL, Bayati J, Baramki TA (1990) Follicular phase gonadotropin-releasing hormone agonist and human gonadotropins: a better alternative for ovulation induction in in vitro fertilization. Fertil Steril 53(2):302–305

    Article  CAS  PubMed  Google Scholar 

  14. Sunkara SK, Coomarasamy A, Faris R, Braude P, Khalaf Y (2014) Long gonadotropin-releasing hormone agonist versus short agonist versus antagonist regimens in poor responders undergoing in vitro fertilization: a randomized controlled trial. Fertil Steril 101(1):147–153

    Article  CAS  PubMed  Google Scholar 

  15. Ou J, Xing W, Li Y, Xu Y, Zhou C (2015) Short versus long gonadotropin-releasing hormone analogue suppression protocols in IVF/ICSI cycles in patients of various age ranges. PLoS ONE 10(7):e0133887

    Article  PubMed  PubMed Central  Google Scholar 

  16. Practice Committee of the American Society for Reproductive Medicine (2018) Electronic address: ASRM@asrm.org. Comparison of pregnancy rates for poor responders using IVF with mild ovarian stimulation versus conventional IVF: a guideline. Fertil Steril 109(6):993–999.

  17. Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP, Fauser BC, Broekmans FJ (2009) The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update 15(1):5–12.

  18. Miserez Zaugg C, Fournet Irion N, Cantero-Perez P, Streuli I (2014) Résultats de la fécondation in vitro en cycle naturel ou avec une stimulation hormonale minimale [Results of in vitro fertilization in natural cycle or with mild stimulation]. Rev Med Suisse 10(447):1969–1970, 1972–1974, 1976. French.

  19. Wang J, Zhang J, Zhao N, Ma Y, Wang X, Gou X, Ju Y, Zhang H, Chen S, Wang X (2022) The effect of ovarian stimulation on aneuploidy of early aborted tissues and preimplantation blastocysts: comparison of the GnRH agonist long protocol with the GnRH antagonist protocol. J Assist Reprod Genet 39(8):1927–1936

    Article  PubMed  PubMed Central  Google Scholar 

  20. La Marca A, Capuzzo M, Sacchi S, Imbrogno MG, Spinella F, Varricchio MT, Minasi MG, Greco P, Fiorentino F, Greco E (2020) Comparison of euploidy rates of blastocysts in women treated with progestins or GnRH antagonist to prevent the luteinizing hormone surge during ovarian stimulation. Hum Reprod 35(6):1325–1331

    Article  PubMed  Google Scholar 

  21. Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB (2000) Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril 73:1155–1158

    Article  CAS  PubMed  Google Scholar 

  22. L’Heveder A, Jones BP, Naja R, Serhal P, Nagi JB (2021) Preimplantation genetic testing for aneuploidy: current perspectives. Semin Reprod Med 39(1–2):1–12

    PubMed  Google Scholar 

  23. Capalbo A, Poli M, Jalas C, Forman EJ, Treff NR (2022) On the reproductive capabilities of aneuploid human preimplantation embryos. Am J Hum Genet 109(9):1572–1581

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kyrou D, Verpoest W, Staessen C, De Vos A, Haentjens P, Liebaers I, Devroey P (2011) No relationship between the type of pituitary suppression for IVF and chromosomal abnormality rates of blastomeres: an observational study. Fertil Steril 95(2):563–567

    Article  PubMed  Google Scholar 

  25. Baart EB, Macklon NS, Fauser BJ (2009) Ovarian stimulation and embryo quality. Reprod Biomed Online 18(Suppl 2):45–50. https://doi.org/10.1016/s1472-6483(10)60448-8

    Article  PubMed  Google Scholar 

  26. Lambalk CB, Banga FR, Huirne JA, Toftager M, Pinborg A, Homburg R, van der Veen F, van Wely M (2017) GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update 23(5):560–579

    Article  CAS  PubMed  Google Scholar 

  27. Ata B, Capuzzo M, Turkgeldi E, Yildiz S, La Marca A (2021) Progestins for pituitary suppression during ovarian stimulation for ART: a comprehensive and systematic review including meta-analyses. Hum Reprod Update 27(1):48–66

    Article  CAS  PubMed  Google Scholar 

  28. Yang L, Luo K, Lu G, Lin G, Gong F (2022) Euploidy rates among preimplantation genetic testing for aneuploidy cycles with oral dydrogesterone primed ovarian stimulation or GnRH antagonist protocol. Reprod Biomed Online 45(4):721–726

    Article  CAS  PubMed  Google Scholar 

  29. Pai AH, Sung YJ, Li CJ, Lin CY, Chang CL (2023) Progestin Primed Ovarian Stimulation (PPOS) protocol yields lower euploidy rate in older patients undergoing IVF. Reprod Biol Endocrinol 21(1):72

    Article  PubMed  PubMed Central  Google Scholar 

  30. Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, Macklon NS, Fauser BC (2007) Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Hum Reprod 22(4):980–988

    Article  PubMed  Google Scholar 

  31. Irani M, Canon C, Robles A, Maddy B, Gunnala V, Qin X, Zhang C, Xu K, Rosenwaks Z (2020) No effect of ovarian stimulation and oocyte yield on euploidy and live birth rates: an analysis of 12 298 trophectoderm biopsies. Hum Reprod 35(5):1082–1089

    Article  CAS  PubMed  Google Scholar 

  32. Barash OO, Hinckley MD, Rosenbluth EM, Ivani KA, Weckstein LN (2017) High gonadotropin dosage does not affect euploidy and pregnancy rates in IVF PGS cycles with single embryo transfer. Hum Reprod 32(11):2209–2217

    Article  CAS  PubMed  Google Scholar 

  33. Wu Q, Li H, Zhu Y, Jiang W, Lu J, Wei D, Yan J, Chen ZJ (2018) Dosage of exogenous gonadotropins is not associated with blastocyst aneuploidy or live-birth rates in PGS cycles in Chinese women. Hum Reprod 33(10):1875–1882

    Article  CAS  PubMed  Google Scholar 

  34. Meniru GI, Craft IL (1997) Utilization of retrieved oocytes as an index of the efficiency of superovulation strategies for in-vitro fertilization treatment. Hum Reprod 12(10):2129–2132

    Article  CAS  PubMed  Google Scholar 

  35. Timeva T, Milachich T, Antonova I, Arabaji T, Shterev A, Omar HA (2006) Correlation between number of retrieved oocytes and pregnancy rate after in vitro fertilization/intracytoplasmic sperm infection. Sci World J 21(6):686–690

    Article  Google Scholar 

  36. Yu R, Jin H, Huang X, Lin J, Wang P (2018) Comparison of modified agonist, mild-stimulation and antagonist protocols for in vitro fertilization in patients with diminished ovarian reserve. J Int Med Res 46(6):2327–2337

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Kuan KKW, Omoseni S, Tello JA (2023) Comparing ART outcomes in women with endometriosis after GnRH agonist versus GnRH antagonist ovarian stimulation: a systematic review. Ther Adv Endocrinol Metab 4:14

    Google Scholar 

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Acknowledgements

The authors thank our patients and all participants in the data collection.

Funding

Supported by grants from the Natural Science Foundation of Shanghai Municipality (grant No. 21ZR1450700).

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Authors and Affiliations

  1. School of Medicine, Shanghai First Maternity and Infant Hospital, Centre for Reproductive Medicine, Tongji University, #2699, Gaoke West Road, Shanghai, 200092, China

    Yu Wang, Junting Xu, Xiangjie Yin, Yuan Fang & Kunming Li

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  1. Yu Wang
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  2. Junting Xu
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  3. Xiangjie Yin
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  4. Yuan Fang
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  5. Kunming Li
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Contributions

KL and YW contributed to the study’s conception and design. Data collection and analysis were performed by YW and JX. The first draft of the manuscript was written by YW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kunming Li.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study obtained the approval of Research Ethics Committee of Shanghai First Maternity and Infant Hospital. Written informed consent was waived due to the retrospective nature, and patients’ data were used anonymously.

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Wang, Y., Xu, J., Yin, X. et al. The comparision among euploidy of preimplantation blastocysts in different controlled ovary stimulation (COH) protocols. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07474-6

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  • DOI: https://doi.org/10.1007/s00404-024-07474-6

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